Provider Demographics
NPI:1780659532
Name:CRAWFORD, MARY E (DPM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 NASSAU ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4137
Mailing Address - Country:US
Mailing Address - Phone:425-339-8888
Mailing Address - Fax:425-258-6933
Practice Address - Street 1:3131 NASSAU ST
Practice Address - Street 2:SUITE #101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4137
Practice Address - Country:US
Practice Address - Phone:425-339-8888
Practice Address - Fax:425-258-6933
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR56231OtherREGENCE BLUESHIELD
WA69528OtherWORKER'S COMPENSATION
WA5912491OtherAETNA U.S. HEALTHCARE
WA1055565Medicaid
WA1055565Medicaid